Provider Demographics
NPI:1255310108
Name:KATZ, DAVID MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARSHALL
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 CHAMPION BLVD STE G11-535
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2473
Mailing Address - Country:US
Mailing Address - Phone:615-464-5500
Mailing Address - Fax:614-645-5015
Practice Address - Street 1:6405 CONGRESS AVE STE 160
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2861
Practice Address - Country:US
Practice Address - Phone:561-464-5500
Practice Address - Fax:561-464-5501
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 039970 E208100000X
FLME102631207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015809000Medicaid
FL015809000Medicaid
PARA 633976Medicare ID - Type Unspecified